乳腺癌术后大分割短疗程放射治疗的临床研究

目的研究乳腺癌术后大分割放射治疗的疗效、疗程、副反应以及替代常规放射治疗的可能性.方法60例乳腺癌术后需放射治疗病例被随机均分至大分割放射治疗组(HOFRT组)和常规放射治疗组(CRT组).两组病例根据TNM分期、腋淋巴结转移数等设内乳野、锁腋野、胸壁野,采用6MV X线、电子线照射;HOFRT组的胸壁野照射采用切线对穿野照射.HOFRT组第1、3天为5.0 Gy/次,第15、17天为6.5 Gy/次.共DT23 Gy,4分次,17 d完成.CRT组2.0～2.5 Gy/次,共DT45～50Gy,20～25分次,4～5周完成.HOFRT组10例和CRT组9例腋窝后野加量10～15Gy,5～7分次,5～7 d完成.HOFRT和CRT组的总疗程分别为3.1～3.4、4.7～6.0周.结果HOFRT、CRT组的5年总生存率分别为65.8%、76.9%;Ⅲ期5年生存率分别为59.8%、80.0%(P＞0.05);局部复发率分别为10.7%、7.4%(P＞0.05).HOFRT组的局部复发、生存率等与CRT组相似.HOFRT组放射治疗晚期损伤导致的患侧上肢淋巴水肿、活动受限分别为8、6例,与CRT组相似(CRT为14、7例,P＞0.05).HOFRT组急性2～3级放射性皮肤损伤显著低于CRT组(313),明显减少由于急性损伤延长放射治疗疗程.结论大分割放射治疗是一种短疗程、安全、有效的乳腺癌术后放射治疗方案,局部复发、生存率和疗后晚期并发症与常规放射治疗无差异,具有替代常规放射治疗的可能性.     

乳腺癌术后胸壁低分割放疗的长期疗效观察

目的探讨乳腺癌术后胸壁低分割放疗的长期疗效和不良反应。方法 106例Ⅱ、Ⅲ期（UICC,1989）乳腺癌患者,均为首次治疗,手术方式为根治术或改良根治术。术后胸壁放疗采用6 MeV电子线,3.6Gy/次,隔日照射,3次/周,总剂量为39.6 Gy,分11次,近4周完成。结果随访时间为61～160个月,中位随访时间为106.7个月。低分割放疗后5年胸壁复发7例（6.6%）,5年无瘤生存率为67.9%（72/106）,5年总生存率为74.5%（79/106）,10年总生存率为74.5%（79/106）。急性皮肤湿性反应发生率为4.7%（5/106）,晚期中上肺部局部放射性纤维化发生率为5.1%（4/78）。结论低分割放疗与常规照射方案比较,疗效相当,早晚期不良反应无明显增加。     

后程超分割调强放疗联合化疗治疗中晚期鼻咽癌的临床研究

目的:评价后程超分割放疗联合化疗治疗Ⅲ～Ⅳa鼻咽癌的疗效.方法:60例Ⅲ～Ⅳa期鼻咽癌采用随机分组为常规组、后程超分割同步化疗组.均先采用面颈联合野常规分割对穿照射40 Gy,20次4周完成.后超组缩野后改用后程超分割调强放疗,1.2Gy/次,2次/天,共14-15天完成.鼻咽病灶总DT 73.6～76Gy/7周.且在放疗同时给予PF方案治疗.对照组缩野后给予常规照射2Gy/次,鼻咽病灶DT 70～74Gy/35～37次/7～7.5周.结果:后程超分割调强放疗同步化疗组与常规组肿瘤消退率分别为96.6%(29/30)、93.3%(28/30)(P＞0.05),1、3年肿瘤局部控制率分别为93.1%、89.6%和82.1%、67.8%.1、3年生存率分别为96.5%、93.1%和92.8%、71.4%(P＜0.05).后程超分割调强放疗同步化疗组的急性放疗反应显著高于常规分割放疗组.远期不良反应如口干及颈部软组织纤维化低于常规分割放疗组.结论:后程超分割调强放疗可提高局部晚期鼻咽癌的局控率及生存率,放化疗结合可降低远处转移率,毒副反应可耐受.     

乳腺癌根治术后放射治疗胸壁及腋窝的临床意义

目的　探讨乳腺癌根治术后放射治疗胸壁、腋窝的临床意义。方法　资料完整 ,经过随访病例 14 6例 ,其中ⅡA4 7例 ,Ⅱb5 3例 ,ⅢA38例 ,Ⅲb8例。合并胸壁放疗组 4 6例 (胸壁组 ) ;放疗锁骨上区、内乳区 5 0例(2野组 ) :放疗锁骨上区、内乳区及腋窝 5 0例 (3野组 )。每野照射剂量 5 0 - 5 5GY ,5 0～ 5 6周完成。结果　1、3、5年局部控制率 (包括胸壁、锁骨上区、内乳区腋窝 ) ,胸壁组分别为 98 0 %、95 5 %、95 5 % ;2野组分别为 87 8%、82 4 %、79 4 % ,3野组分别为 91 5 %、84 2 %、80 8%。胸壁组与 2野组比 χ2 =4 5 2 4 (P <0 0 5 ) ;胸壁组与 3野组与 χ2 =3.4 86 (P =0 .0 5 6 )。胸壁复发率 :胸壁组为 2 2 % ,未照射胸壁 (2野组 +3野组 )者为13% ,χ2 =4 2 5 9(P <0 0 5 )。腋窝复发率 :2野组不照射腋窝 ,3野组照射腋窝 ,复发各为 8%、2 % ,(P >0 0 0 5 ) ,患侧上肢水肿发生率各为 14 %、38% ,(P <0 0 1)。 1、3、5年生存率 ,胸壁组分别为 97 8%、85 1%及80 3% ;2野组分别为 95 1%、83 4 %及 71 7% ;3野组分别为 93 8%、82 9%及 6 5 7%。胸壁组与 2野组、3野组相比 ,P均 >0 0 5。远处转移 ,胸壁组 10 8% ,2野组 8 0 % ,3野组 10 % ,P均 >0 0 5。结论　胸壁放射治疗 ,可明显     

乳腺癌低氧放疗的远期观察

目的:观察低氧对乳腺癌术后放疗皮肤保护作用和对远期疗效的影响。方法:选自1992年3月至1995年3月收治的乳腺癌根治术后患者158例。Ⅱ期91例,Ⅲ期67例。随机分为低氧放疗组85例,常规放疗组73例。应用电子线照射锁骨上、腋窝、胸壁和内乳区。低氧放疗组在放疗开始前吸入10.5%的低氧3～5min直至照射结束。总剂量50～55Gy/25～27次。结果:低氧放疗组照射野内的急性皮肤反应明显较常规放疗组轻,而且出现的晚,但照射野内的后期皮肤改变两组无明显差别。5年生存率分别为92.9%和94.5%,χ2检验无统计学意义。结论:低氧放疗对正常皮肤有明显保护作用,而对生存期无明显影响。     

后程加速超分割三维适形放疗治疗食管癌的疗效分析

目的探讨后程加速超分割三维适形放疗治疗食管癌的疗效和不良反应。方法将110例食管癌患者随机分为后程加速超分割三维适形放疗组(试验组)和单纯三维适形放疗组(对照组),每组55例,均采用6MV X线外照射。试验组患者前2/3疗程采用三维适形放疗,总剂量38Gy分19次,后1/3疗程采用后程加速超分割三维适形放疗,每次1.4 Gy,每天2次,间隔6h以上,补量总剂量28Gy,至总剂量66Gy结束疗程。对照组采用单纯三维适形放疗,总剂量66Gy分33次。比较两组患者的治疗效果。结果试验组患者的1年、3年和5年生存率分别为78.2%、52.7%和32.7%,对照组患者分别为69.1%、43.6%和25.5%,两组差异无统计学意义(P>0.05)。结论后程加速超分割三维适形放射治疗食管癌具有提高生存率的趋势。     

Ⅱ、Ⅲ期乳腺癌术后三种放疗方式的比较研究

目的：探讨Ⅱ、Ⅲ期乳腺癌术后适宜的胸壁和锁骨上区照射方式。方法：156例患者随机分成A、B、C三组,给予不同放疗方式。A组锁骨上区和胸壁给予常规电子线照射,2Gy/次,1次/d,5d/周,总量至50Gy。B、C组电子线放疗至32Gy后,分别改用4野调强和三维适形切线放疗,剂量均为DT18Gy分9次11d完成。比较三组不良反应和疗效。结果：三组放射性皮肤反应发生率、胸壁复发率无差异（P〉0.05）;放射性肺损伤发生率分别为32.7%、10.4%、22.6%（P〈0.05）,B组最低,A组最高;远处转移率分别为36.3%、8.3%、37.7%（P〈0.01）,B组最低,A、C两组无差异。结论：三种放疗方式在皮肤反应和局部控制率上无差别;电子线＋4野调强能减少放射性肺损伤发生,而对控制远处转移发生的作用尚需进一步研究。     

化疗与后程加速超分割联合治疗食管癌临床观察

目的评价化疗联合后程加速超分割放射治疗食管癌的疗效.方法70例食管癌患者,随机分为2组,化放组36例,单纯放疗组34例.放疗采用60Co γ线外照射,先前一后二野等中心照射40 Gy后改用后程加速超分割放疗,(2次/d,1.5 Gy/次),全疗程总剂量共67～70Gy,化疗采用5-FU CF DDP.结果化放组与单放组1、3、5年生存率分别为71.0%、51.6%、29.1%和48.1%、30.0%、10.2%,两组对比差异有显著性(P＜0.05)结论化疗加后程加速超分割治疗食管癌能提高生存率,患者容易耐受.     

局限期小细胞肺癌放化疗综合治疗

[目的]研究常规放疗及加速超分割放疗联合化疗治疗局限期小细胞肺癌的近期疗效及生存期.[方法]1998年2月至2000年5月间,局限期小细胞肺癌共72例随机分为2组,常规放疗组34例和加速超分割放疗组38例.两组接受EP方案化疗2个疗程后开始放疗.常规放疗组2Gy/次,每天1次,每周5次,总量(56～60)Gv/(5.6～6)w.加速超分割组放疗1.4Gy/次,每日2次,2次间隔≥6小时,每周5日,总量56Gy/4w.放射野包括原发灶,同侧肺门、纵隔淋巴引流区.2组病人在完成放疗后继续EP方案化疗4个疗程.[结果]全组总有效率77.8%,中位生存期18个月,常规放疗组和加速超分割放疗组两组近期疗效分别为70.6%和84.2%(P＞0.05),两组1、2、3年生存率分别为76.5%、23.3%、10.9%和80.0%、32.6%、11.7%(P＞0.05).[结论]加速超分割放疗组的近期疗效及长期生存率等同于常规分割放疗组.     

17例内窥镜下早期食管癌的放疗疗效

目的　探讨内窥镜下早期食管癌的放疗疗效。方法　17例早期食管癌经内窥镜及碘染色确诊,并经活检病理证实。6MVX线3个野外照射,先常规分割30Gy ,15分次,3周完成;复位后行后程加速超分割照射,1.5Gy/次,2次/d ,间隔6h以上,共2 0～2 4Gy ,14～16分次,9～10d完成。生存率分析采用Kaplan Meier法。结果　17例早期食管癌放疗1、3、5年生存率分别为10 0 %、86 %、6 6 %。病变长度≤3cm的5年生存率为10 0 % ,>5cm的为4 9% (P =0 .111)。病变厚度≤5mm的5年生存率为10 0 % ,>5mm的为4 5 % (P =0 .10 2 )。结论　早期食管癌放疗是有效的方法,照射野大小应根据内窥镜及碘染色所确定的病变范围而定;常规分割30Gy15分次3周+后程加速超分割2 0～2 4Gy14～16分次9～10d照射是可行的。     

原发性肝癌三维适形放疗114例疗效评价

观察三维适形放射治疗（three-dimensional conformal radiotherapy,3DCRT）原发性肝癌的临床疗效.对114 例原发性肝癌患者在CT 定位下以3～5 mm层厚连续扫描,静脉双期碘造影剂增强扫描,精确定位治疗靶区并制定3DCRT计划,使90%等剂量曲线包绕计划靶体积（planning target volume,PTV）.以Varian 2100C 直线加速器实施放疗计划照射剂量1.8～2 Gy/次,5次/周,总剂量50～66 Gy,总疗程5～7周.治疗后1个月33例部分缓解,3个月42例部分缓解,6个月53例部分缓解.1、2和3年生存率分别为52.6%、35.1%和 28.9%.初步研究结果提示,3DCRT是原发性肝癌的有效无创治疗手段.     

Comparison of Effects of Hemoglobin Levels Upon Tumor Response among Cervical Carcinoma Patients Undergoing Accelerated Hyperfractionated Radiotherapy versus Cisplatin Chemoradiotherapy

Purpose: Blood hemoglobin levels are known to influence response to radiotherapy. This retrospectiveanalysis compared the effect of hemoglobin levels upon response to radiation among patients treated withradiation alone (by accelerated hyperfractionated radiotherapy) versus those treated with concurrent cisplatinchemoradiotherapy. Materials and Methods: Among patients treated for locally advanced carcinoma of thecervix (LACC) during 2009-10, a total of 60 fulfilled the eligibility criteria. In this time frame, external beamradiotherapy was delivered with either concurrent chemoradiotherapy (CRT, n=31) (45Gy over 25 fractions,with weekly cisplatin at 40mg/m2), or with accelerated hyperfractionated radiotherapy (AHRT, n=29) (20Gyover 10 daily fractions over the first two weeks, followed by 30Gy over 20 fractions over the next two weeks,with two fractions of 1.5Gy per day, without the use of chemotherapy). Mean weekly hemoglobin (MWH) levelsof all patients were calculated as the arithmetic means of weekly recorded blood hemoglobin levels. As perMWH, patients in both of the AHRT or the CRT groups were classified into two subgroups- those with MWHbetween 10-10.9g/dL, or with MWH>11g/dL. Complete response (CR) to external beam RT phase (prior tobrachytherapy) was declared after clinical examinations and computed tomography. The CR rate was noted forboth MWH sub-groups within each of the AHRT and CRT groups. Results: Within the AHRT group, patientswith MWH>11g/dL had a much better CR rate in comparison to those with MWH:10-10.9g/dL (80% vs. 21.1%)which was statistically significant (p 0.0045). Within the CRT group, there was no significant difference in theoutcomes within the MWH>11g/dL and MWH:10-10.9g/dL sub-groups ( CR rates of 80% vs. 61.9%, p=0.4285).Conclusions: The importance of maintaining a minimum hemoglobin level of 11g/dL during RT is much greaterfor patients treated with RT alone, than for patients treated with concurrent chemoradiotherapy. Enhancedhaemoglobin levels during RT may to an extent negate the ill-effects that may otherwise arise due to non-use ofconcurrent chemotherapy.     

Combined chemo- and radiotherapy vs. radiotherapy alone in the treatment of primary, nonresectable adenocarcinoma of the rectum

PURPOSE: In a randomized study in primarily inextirpable rectal cancer, conventional radiotherapy to reduce the tumor mass was compared with combined chemotherapy and radiotherapy. METHODS AND MATERIALS: The combined treatment (CRT) was given every other week, four times, during a 7-week period. The drugs used were methotrexate, 5-fluorouracil in bolus injection followed by continuous infusion and leucovorin rescue. Radiotherapy (RT) was given simultaneously with five 2-Gy fractions in 3 days to a dose of 10 Gy to a total dose in the four courses of 40 Gy. This regimen was compared with radiotherapy in 2-Gy fractions to a total dose of 46 Gy in the radiotherapy group. Surgery was performed 3-4 weeks after finished treatment. Seventy patients were included between November 1988 and August 1996; 36 patients were allocated to RT and 34 to CRT. RESULTS: Twenty-five (74%) of the patients in the CRT group underwent a locally radical resection with 20 (59%) patients without any known metastases. The corresponding figures in the RT group were 23 (64%) and 18 (50%), respectively. Among the patients who underwent any tumor resection, 5/29 (17%) in the CRT group and 12/27 (44%, p = 0.05) in the RT group have had a local recurrence. After a locally radical resection, the corresponding figures are 4% and 35% (p = 0.02), respectively. Local disease-free survival was significantly superior in the CRT group (66% at 5 years) compared with the RT group (38%, p = 0.03 log-rank test). Five-year survival was 29% (9 patients) in the CRT group and 18% (6 patients) in the RT group, a nonsignificant difference (p = 0.3). Five patients in the RT group did not complete planned treatment, mainly due to the appearance of metastatic disease. In this group toxicity was usually of Grade 0-1. In the experimental group, the toxicity usually was Grade 2 or higher, and 6 patients did not manage to fulfill the planned treatment due to toxicity. CONCLUSION: In this study, with fewer included patients than intended, resectability rates were high in both groups. The addition of chemotherapy to radiotherapy significantly improved local control rates, but no statistically significant difference was found in survival between the groups. The acute toxicity after CRT was higher than after RT alone, but manageable.     

后程加速超分割放射治疗食管癌的临床研究

目的研究后程加速超分割放射治疗食管癌的疗效.方法1997年10月～1999年10月我院治疗食管癌患者120例,随机分为两组:常规分割放疗(CFR)组60例,每天1次,每次2 Gy,每周5次,总肿瘤剂量70Gy;后程加速超分割放疗(LCAHR)组60例,常规分割放疗40 Gy后改为每天2次,每次1.5Gy,每次间隔6 h,每周10次,总肿瘤剂量70Gy.结果LCAHR组和CFR组1,2,3年生存率分别为73.3%、53.3%、40.0%和63.3%、53.3%、50.0%;LCAHR组和CFR组1,2,3年局控率分别为56.6%、26.7%、16.7%和36.7%、30.0%、26.7%,两组差异有显著性(P＜0.05).结论后程加速超分割放射治疗食管癌照射方法优于常规分割放疗.患者能耐受,值得临床进一步研究.     

同期放化疗治疗晚期口腔癌的临床观察

目的　探讨以顺铂为基础方案同期放化疗治疗中晚期口腔癌的疗效及急性毒性反应。方法　回顾分析４２例Ⅲ、ⅣＡ期或手术后复发的口腔鳞癌患者资料,分为放化疗组和单放组。放化疗组２２例患者行根治性外照射（４～８ＭＶＸ线,６０～７０Ｇｙ）,并于第１、４、８周行以顺铂（８０ｍｇ／ｍ^２）为基础的联合化疗;单放组２０例行单纯放疗（剂量同放化疗组）,观察比较两组近期疗效及急性毒性反应情况。结果　放化疗组和单放组有效率分别为８１。８％和６０。０％,１年生存率分别为４５。０％（９／２０）和２３。５％（４／１７）,２年生存率分别为２５。０％（４／１６）和７。７％（１／１３）,放化疗组的中位无局部进展生存期较单放组延长２个月。两组主要急性毒性反应为口腔黏膜炎、放射性皮炎、白细胞减少和恶心呕吐,放化疗组发生率均高于单放组,其中３～４级口腔黏膜炎两组差异显著（Ｐ＜０.０１）。结论　同期放化疗治疗晚期或手术后复发口腔癌的近期疗效优于单纯放疗,但主要不良反应中３～４级口腔黏膜炎较明显,需积极的对症及支持治疗。     

甘氨双唑钠降低头颈部鳞癌患者严重放射性黏膜炎的Ⅱ期随机临床研究

目的 观察放射增敏剂甘氨双唑钠(CMNa)对局部晚期头颈部鳞癌患者IMRT同步化疗期间咽部黏膜炎的影响。方法 2014—2015年间63例患者按照1∶2比例随机入组同步放化疗+ CMNa (CRT+CMNa)和同步放化疗(CRT),57例完成治疗方案。CMNa 800 mg/m²为放疗前30 min静脉滴注,隔天使用。CRT方案为PGTV和阳性淋巴结处方剂量69.96~73.92 Gy分33次,PTV处方剂量为60.06 Gy分33次,顺铂100 mg/m²。放疗技术采用IMRT或HT。结果 CRT+CMNa组19例,CRT组38例。两组间基线临床资料相近(P=0.34~1.00),PGTV (73.00 ± 2.66) Gy比(71.66 ± 3.99) Gy,P=0.19)、PTV (60.58 ± 2.27) Gy比(59.67 ± 2.08) Gy,P=0.14)处方剂量相近,化疗周期数也相近(P=0.28)。CRT+CMNa较CRT组放疗期间≥3级放射性黏膜炎发生率下降,分别为32%、61%(P=0.04),疼痛VAS评分降低,分别为4.6±1.6、6.2±1.6(P=0.00),放疗期间抗生素使用和血液毒性两组也相近(P=0.08~0.80)。结论 CMNa可以减轻头颈部鳞癌IMRT同步化疗期间黏膜炎发生率和程度及疼痛评分。     

放化疗中不同化疗方式对N3期鼻咽癌预后影响

目的 评价放化疗中不同方式化疗对N3期鼻咽癌患者预后的影响.方法 回顾分析114例N3期鼻咽癌患者资料.9例接受单纯放疗;105例接受以铂类为基础化疗联合放疗,其中同期放化疗37例,诱导化疗+同期放化疗53例,同期放化疗+辅助化疗15例.鼻咽原发灶采用60Co γ线、6 MV X线常规分割照射70 Gy,颈部根治量60～68 Gy,颈部预防量54～60 Gy.结果 中位随访时间54个月,共51例患者死亡.全组5年总生存率为59.1%.单纯放疗、同期放化疗、诱导化疗+同期放化疗、同期放化疗+辅助化疗的5年总生存率分别为17%、51%、68%、71%(X2=15.44,P=0.001),无复发生存率分别为83%、77%、88%、93%(X2=2.34,P:0.505),无转移生存率分别为17%、54%、72%、80%(X2=19.28,P=0.000).结论 诱导化疗+同期放化疗及同期放化疗+辅助化疗方式对N3期鼻咽癌患者比单纯同期放化疗更具优势,最有效治疗方式有待随机研究证实.

Abstract：

Objective Nasopharyngeal carcinoma patients with stage N3 disease are prone to develop distant metastasis even treated with standard concurrent chemoradiotherapy(CRT).The aim of this study is to compare the ettlcacy of difierent chemotherapy sequences in these patients.Methotis All patients with histologically proven,carcinoma of the nasopharynx treated between July 1999 and November 2003 were restaged according to the AJCC 2002 stage classification system.A total of 114 patients had AJCC N3 diseases were analyzed retrospectively.Patients were treated by conventional RT technique using 6 MV photons or 60 Coγ-ray with 1.8-2.0 Gy per fraction,5 fractions a week,to a planned dose of 70 Gy.The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The prophylactic irradiation dose of the neck wss 54-60 Gy.Any positive lymph node was boosted to a total dose of 60-68 Gy.All patients received cisplatin-based chemotherapy of difierent sequences but 9 patients received RT alone.CRT regimen was delivered in 37 patients,neoadjuvant chemotherapy(NACT)+CRT regimen in 53 patients and CRT+adjuvant chemotherapy(AC)regimen in 15 patients.Results The median follow up time was 54 months(3-117months).The 5-year overall survival rate was 59.1%in whole groups,and with 17%,51%,68%and 71%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=15.44,P=0.001).The 5-year relapse-free survival rates were 83%,77%,88%and 93%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=2.34,P=0.505).The 5-year metastasis-free survival rates were 17%,54%,72%and 80%in RT,CRT,NACT+CRT and CRT+AC group,respectively(X2=19.28,P=0.000).Conclusions The NACT+CRT and CRT+AC regimens were more effective than CRT alone for N3 disease in the current study.Large prospective,randomized clinieal studies are warranted.     

腔内热疗合并体外放射治疗食管癌的疗效

目的：比较食管腔内微波加温合并体外放射治疗食管癌与单纯放射治疗的疗效。方法：对125例食管癌进行前瞻性分组研究。食管腔内加温合并体外照射（R＋H）组59例,单纯体外照射（RT）组66例,R＋H组外照射DT40Gy,腔内加温1－2次／周,45min／次,要求肿瘤表面温度＞43℃。RT组外照射DT60Gy,2Gy／次,5次／周。结果：近期疗效显著,R H 完全缓解率达46．0％,RT组为24．0％,差异有显著性意义（P＜0．05）。1、5、10年生存率R＋H组分别为81．2％,23．7％和15．2％,RT组分别为59．0％、16．7％和7．5％。将平均T90≥43℃的病例进行统计,R＋H组的5、10年生存率是26．9％和17．3％,分别高出对照组10．2％和9．8％。结论、食管腔内加温合并体外放射治疗可以提高食管癌的局部控制率,近期疗效和远期疗效均高于对照组,局部控制率的高低与加温的次数无明显关系,关键在于每次的加温质量（T90的高低）。     

食管癌患者同期放化疗顺铂加氟尿嘧啶方案Ⅱ期临床试验

背景与目的：国外已有研究表明,同期放化疗是局部晚期食管癌的标准治疗方案,但国内文献报道同期放化疗的疗效不尽相同,同期放化疗能否提高生存率尚无定论。本研究目的是评价PF方案同期放化疗对食管癌的疗效,并观察毒性。方法：44例食管鳞癌患者随机分为同期放化疗组（简称同期组）和后程加速超分割组（简称后超组）。同期组22例,全程常规分割照射,每天一次,每次2．0Gy,每周5次,25分割,总剂量50Gy。于放疗的第1天开始化疗：顺铂52．5mg／m^2 d1,氟尿嘧啶700mg／m^2 d1-d5,每28d重复,共4周期。后超组22例：总剂量60Gv,前半程30Gv同放化疗组,3周完成;后半程30Gv加速超分割照射,每日2次,间隔至少6h,每次1．5Gy,每周10次,2周完成。结果：同期组有效率高于后超组,分别为95．5％和86．4％,但差异无统计学意义（P=0．607）。同期组2年局控率和2年生存率分别为72．2％和56．7％,后超组分别为39．0％和31．6％。同期组获得了更高的局控率和生存率,但只有局控率差异有统计学意义（P=0．014）。两组的主要急性反应为放射性食管炎、放射性肺炎,晚期反应为食管和肺损伤。两组的急性和晚期反应均较轻。结论：同期放化疗与后程加速超分割相比,显著提高了食管癌局控率,有提高生存率的趋势,毒性可以耐受。     

68例垂体瘤放射治疗的临床分析

背景与目的：垂体瘤是比较常见的颅内肿瘤,主要的治疗方法有手术,放射治疗等,本文比较不同治疗方法对垂体瘤的效果。以及对不同类型垂体瘤的疗效。方法：从1980年3月到1992年1月,68例垂体瘤行放射治疗,37例不分泌激素,52例为术后放射,16例为单纯放射,均为常规放射,中位剂量为49.7Gy(25.6-65Gy),采用^60Coγ线照射45例,8MVX线照射10例,18MVX线照射13例。结果：全组总的5年生存率为94.1%,10年生存率76.8%,全组总的局部控制率5年和10年分别为94%和89.1%。男性5年和10年的局部控制率89.7%,89.7%,女性分别为97%和88.4%,P=0.2985,从照射剂量来看,50Gy以下和50Gy以上总的局部控制率分别为82%和94%,两者比较P=0.1796。三野及旋转治疗略高于双颞侧野照射,激素分泌,病理类型以及各种射线之间均无差异。8例死于肿瘤复发,照射剂量在50Gy以下的39例。仅1例发生并发症,而照射剂量在50Gy以上的29例病人,有5例发生并发症,P值为0.0058,有显著性差异。结论：垂体瘤的照射剂量宜在45-50Gy,最好能采用三野照射。